Contact Lens Care & Compliance

GPC and GP Lens Care

September 1, 2010

Contact Lens Care & Compliance

GPC and GP Lens Care

By Michael A. Ward, MMSc, FAAO

A 61-year-old male GP lens wearer presented with complaints of excessive lens movement and clouding of his vision. He denied ocular itching, redness, and pain. He was currently wearing GP segmented bifocal contact lenses, which I had fitted approximately seven years prior. He had not returned for an ocular exam/contact lens evaluation in the last five years because he was "doing great." To care for his lenses he was using Boston Simplus (Bausch + Lomb), which he had switched to approximately one year ago.

The patient had a mild ptosis. Slit lamp evaluation of his superior tarsi revealed giant papillae along with thickening and injection of the palpebral conjunctiva (Figure 1), OD>OS.

Figure 1. Giant papillary conjunctivitis in a GP lens wearer.

Giant Papillary Conjunctivitis

Contact lens-associated giant papillary conjunctivitis (GPC) results from an immunologic reaction to the presence of a foreign body (lens) and the coating of the foreign body with tear proteins (lysozyme, lactoferrin, lipocalin, immunoglobulins), which may be denatured. Palpebral conjunctival thickening, redness, and excess mucous production may be present. Histopathologically, GPC patients exhibit one of the following abnormalities: mast cells in the conjunctival epithelium, and eosinophils and/or basophils in the epithelium or substantia propria. The frequency of GPC is greater and the onset and severity of clinical signs and symptoms are more pronounced among soft lens wearers than among rigid lens wearers.

One-step multipurpose solutions such as Boston Simplus and Opti-Free GP (Alcon) are inadequate for keeping lenses clean for GPC patients. The surfactants in multipurpose solution products are necessarily mild because the solution goes directly onto the eye. The daily regimen of digital lens cleaning cannot be overstressed. In addition to his daily cleaning regimen, our patient will need to be followed monthly for a while, at which time we will use Progent (Menicon) to chemically clean his lenses in the office. CLS

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at mward@emory.edu.